Updated lung cancer screening guidelines could spell 54% surge in LDCT imaging eligibility

New lung cancer guidelines could spell a nearly 54% surge in eligibility for low-dose CT screening, with marked gains in minority populations, experts charged Tuesday in JAMA Network Open.

The influential U.S. Preventive Services Task Force just recently lowered the recommended starting age from 55 down to 50, among other changes, drawing praise from radiologists. Coupled with dropping the smoking history from 30 to 20 pack-years, Kaiser Permanente researchers believe these modifications could produce a 30% uptick in lung cancer diagnoses when compared with previous recommendations.

“While more research must be done, we know from this study we can break down existing barriers in lung cancer screening by expanding eligibility for those who fit the recommended guidelines,” lead author Debra Ritzwoller, PhD, senior investigator at the Kaiser Permanente Institute for Health Research in Colorado, said in a statement. “By screening more individuals sooner, we can potentially help catch lung cancer earlier, effectively saving more lives.”

For their study, Ritzwoller et al. analyzed data from patients who received care across five healthcare systems participating in the Population-based Research to Optimize the Screening Process Lung Consortium (PROSPR). Subjects were treated between 2010-2019, had a complete smoking history, and continuously engaged with one of the organizations for 12 or more months. Researchers compared differences in screening eligibility among this population using the broader 2021 recommendations versus the USPSTF’s previous 2013 parameters.

They found a total sample of more than 341,163 individuals ages of 50-80 who currently or previously smoked. Of those, 34,528 had electronic health records detailing their pack-year number and quit date and were eligible for screening based on 2013 guidance. However, 2021’s update increased that number by 18,533 or 53.7%. This new population included 5,833 individuals ages 50-54 (31.5%) who would have missed the cutoff. This included marked gains among women (52%), Asians/Native Hawaiians/Pacific Islanders (60.6%), Latinos (67.4%), and non-Hispanic Black individuals (69.7%).

Experts said their findings indicate that healthcare systems should plan to increase capacity by 50%-60% to help accommodate this new cohort of patients. This could include bolstering the number of trained radiologists, CT scanners, and thoracic surgeons, the authors advised.

“Improvements in uptake and adherence to annual screening also play a role in increasing this capacity,” Ritzwoller and colleagues wrote. “Screening programs will need to closely monitor capacity strain and allocate resources appropriately to meet evolving demands as the 2021 USPSTF recommendations are adopted in clinical practice.”

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